PCMH Model Great for Health Care, But We Need More Cost Data, Say AAFP Delegates

The patient-centered medical home (PCMH) and technology were front and center during debate at the Reference Committee on Practice Enhancement as delegates flocked to the microphones to tell their stories of PCMH and technology successes and failures during the AAFP Congress of Delegates here on Oct. 15.

Erica Swegler, M.D., points out the lack of data on the costs of implementing a patient-centered medical home, particularly in small and solo practices, during testimony at a reference committee hearing.

Testimony on a resolution asking the Academy to study the effect of the PCMH on the future viability of small practices revealed that many delegates believe in the PCMH model, they just need some help rolling it out, particularly in small and solo practices.

Currently, there is a real lack of data on the costs associated with transforming to a PCMH, said Texas delegate Erica Swegler, M.D., of Keller, during reference committee testimony.

John Cullen, M.D., a delegate from Valdez, Alaska, said he was worried that the costs of transforming to the PCMH model would result in the AAFP losing the rural cohort.

And Missouri delegate Larry Rues, M.D., of Kansas City, said small practices are already doing so much that asking them to also transform to a PCMH is huge. "Small practices can be put out of business because they cannot afford the unintended consequences," of the PCMH, he said.

Then, Kim Yu, M.D., a member from Novi, Mich., rose to give testimony. Her story was a sad one as she told delegates how she had to close her practice a few weeks ago because, in her quest to become a PCMH practice and get meaningful use monies from the federal government, she missed the goal by 1 percent. "We want so desperately to make the PCMH model work, she said, "but we need the support."

Story Highlights

More support for practices transforming to the patient-centered medical home (PCMH) model and with technology were requests from delegates in the Reference Committee on Practice Enhancement.

Delegates and members provided testimony on the positives to be found in a PCMH, but for small and solo practices, the costs may outweigh even the long-term benefits.

Delegates also discussed the positives and negatives of telemedicine before moving on to the need for interoperability in electronic health record systems.

"We all want to make it work, but let's make it work for everyone," said Dale Moquist, M.D., of Sugar Land, Texas. He suggested that the Academy look at having TransforMED gear up to certify medical homes.

Robyn Liu, M.D., the new physician member of the AAFP Board reassured delegates that their concerns were being heard and that the Board was in support of a study that would look at physician costs associated with practice transformation.

In the end, delegates adopted a substitute resolution put forth by the Reference Committee on Practice Enhancement that calls on the AAFP to "study the economic impact of the patient-centered medical home (PCMH) on the future viability of practices, with an emphasis on small and solo practices."

Delegates then moved on to testify on technology, in particular, telemedicine. As technology expands and access to telemedicine increases, more patients will be looking at this type of access and more companies will be interested in providing telemedicine to patients outside of the boundaries of the PCMH, said the Illinois chapter in introducing a resolution on telemedicine.

Delegates Adopt Two Resolutions from Health of the Public and Science

Delegates adopted recommendations from the Reference Committee on the Health of the Public and Science without exception on Oct. 16 at the 2012 Congress of Delegates in Philadelphia.

A substitute resolution supporting the development of healthy food supply chains in supplemental nutrition programs, was adopted by delegates with the intention of broadening the availability of healthy food to program recipients.

In addition, delegates adopted a substitute resolution formally acknowledging and commending the national Tar Wars(www.tarwars.org) program and supporting activities to commemorate the program's 25th anniversary.

The reference committee referred resolutions dealing with the following topics to the AAFP Board of Directors:

endorsing the U.S. Medical Eligibility Criteria for Contraceptive Use;

antibiotic resistance, food production and human health; and

ensuring comprehensive and confidential health care for minors and adults insured as dependents.

"The intent of the resolution is to ask us to take a formal stand on the next new technology to equal retail health clinics," said Illinois delegate Michael Temporal, M.D., of Belleville. He noted that telemedicine has the potential to replace all doctor/patient face-to-face visits. Telemedicine is a welcome access point for continuity of care, said Temporal. "But we don't want those access points replacing continuity of care."

Other delegates, particularly those in rural areas, balked at the idea of taking a stance against telemedicine because it often is widely used for the good of patients in these areas. "Telemedicine can provide access," said Utah delegate Sarah Woolsey, M.D., of Salt Lake City. She advised referring the issue to the Board.

"I don't like telemedicine," said New Jersey delegate Arnold Pallay, M.D., of Montville, "but my patients do this thing (telemedicine) with me all the time."

"We need to embrace the technology and make use of it. We need to be ahead of this curve."

Delegates ultimately referred the issue to the Board of Directors for further study and research.

Delegates also discussed the lack of interoperatability between various electronic health records (EHRs). The consensus was that different EHRs don't talk to one another, and sometimes, even the same EHR systems don't want to talk to one another. William Thrift, M.D., a delegate from Prescott, Ariz., said it was "criminal" that vendors charge so much money and then the programs cannot even talk to one another.

(Then) Board Chair Roland Goertz, M.D., of Waco, Texas, noted that the Board is on top of this issue and is actively advocating that EHR data be interchangeable and exchangeable, leading delegates to reaffirm current policy on the issue.

Delegates also adopted resolutions on

physician awareness and education about risk evaluation and mitigation programs,